HomeMy WebLinkAboutPermit Electrical 2003-6-26
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FA~r(6.Il)726-36sg require specific lA'". "."
ELECTRICAL PERMITAPPUCATlON Zoning (' t"..-
City Job Number c:tE':Z003 - COI ~~ Date ~-/g -03 Dale ;;, /u k 1
Authorized SIgnature ~
3. COiHPLETE FEE SCHEDULE /JELlnv
2.
Electrical Contractor (Jack Vo/ley E/pt:/o't.: C" 200 Amps or less)
201 Amps,to'400:A'fups
n ulJ/ L ,\\.0-.....\)"..(\'\
Address 7::'11'1 Sri IfI'mW<;,f.U'/e.!n 401.A:mps,t0600,'Amps
~\ \'V'",t0';} Gr:;v (j..J
" \~'60 1 ~mps to 10007Amps; .
Q_ L .'" 0' \\' \0":> - Oo-.''':.r \'e~
City KJ(Jtlller'TlJ!1 Phone ,'lu3-'I.,,?/- "'lY'l "",g "'C0ver,1000AmpsIVolts,,e
'V ...ev e-'c:i on'"" ,,\\:,l _0'" ^
\0"'" oo~' ~~Rec,tll!'~c~ <2,nly ~e~" 1>~0"
",,\ ",1). '/..e~' \)\'0' ,,\e e\e 'i..:i.\G
. I' ," 0\e e':> ~'\ -p.... \'" ~o. ,
Supervisor License Number 33 ";>"-eE: Al ~ _" G \,I:)C'i\\Te~or"ry.,~eli\,!,c.es or Feeders
0"" \.\- ,\)\:l 0'0\ ~ \)\\\. ,,'"
I ' ~\G'i). ,,~/; 1>'1 .<?,~' n'<:> ,{I'
10 01 j.. 5 - 'o~ J1, '" ,~\ Ge\'lnstallation, Alteration or Relocation
u ~ ;:./,II"Y>.' ,:'" e U' Q~'
\('> ,,\:l' . ",,<is', ,,~200 ~mps or less
f0"" ~\\"", \0' , '
\:i c~ ':)e~ ,,0\'20 I Amps to 400 Amps
{\0\\' C 40 I Amps to 600 Amps
.;:......
I.
LOCi! TlON OF INSTAUATION
~150 0a.H..'ucw ~-f: StJrit'lj(;lld 971/11
LEGAL DESCRI/TlON f
-r;; Yr:/P -+ /70 JZ2'C)O 02300
JOB mrscRIPTlON
ht1-6" lIoke. u J..r;'!:}
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
. Suspended for 180 days.
CONTRACTOR INSTALLATION ONLY
Expiration Date
Constr. Contr. Number I'I'X-;''I..'t...
Expiration Date
'1-0/.-0.5
Signature of Supervising Electrician
k~
K.. CIa,,' ,., Ote.:>
Address
t/J.(L&c-r 5T~
2.7)'c..:::, G-frT"bN~
<:...)
Owners Name
City
sfP()
Phone
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature.
Inspection Request: 726-3769
A. New Rcsidclllial- Single ur Multi-Family Pl'" dwelling unit.
Service Included
I 000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
,
$50.00
I
B. Services or Feeders - Installation, Altcnlliolls or Relocalion:
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
$ 50.00
$ 69.00
$100.00
Over 600 Amps, or 1000 Volls see "B" above. ~'*'
D. Br:mcb Circuits ' , ,'(.~ ~~ !J\
New Alteration or Exten~~~' ,~~
One Cil' '. I~\.\. ~~ V -t\~~ ~of'43.00
E ~ 41\6;,.~ ~'Jv"
S~~? ~'\..~ .,~ ~ \1>1 $ 3.00
~'\'(.~ ~C~f\) ~~'\)f\).
E. M~!f)~~",,~'us~.S\r-e/fceder not inclnded) -Each Installalion
C ~ \'O~
Pump Jo.~mgation $ 50.00
Sign/Outline Lighting $ 50.00
Limited Energy/Residential $ 25.00
Limited Energy/Commercial $ 45.00 46. on
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4. SUlJTOTflL OFABOVE
J.l.5.0D
,,3./5
l/.fUJ
5,J. "5
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Dri\'c(T;)/Building Forms/Electrical Pcrmit Application I-OJ.doc
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City of Springfield
Electrical Permit Attachment
Status: Issued
225 Fifth Slreet
Springfield, Oregon 97477
541-726-3759 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
ELE2003-00155
6/20/2003
6/20/2003
12/20/2003
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
2750 GATEWAY ST
1703220002300
Springfield
TYPE OF WORK:
TYPE OF USE:
Addition
Commercial
PROJECT DESCRIPTION:
, Data and voice wiring
OWNER/APPLICANT:
TARGET STORES #612
% PROP TAX DEPT
MINNEAPOLIS MN 55440
ELECTRICAL CONTRACTOR:
CACHE VALLEY ELECTRIC COMPANVS03-43 1-6600
919 NORTH .1000
WEST LOGAN UT 84321
CCB # 148222 Expiration Date: 07/06/2005
Deseriotion
Amount Paid
Date Paid
Receiot Numher
+ 10% Administrative Fee
+ 7% State Surcharge
Low Voltage - Commercial Indus
4.50
3.15
45.00
06/20/2003
06/20/2003
06/2012003
1200200000000001596
1200200000000001596
1200200000000001596
To Request an inspection call the 24 hour recording at 726-3769. All inspcctions requested before 7:00 a.m. will be made the same
working day, inspections requested after 7:00 a.m. will be made the following working day.
Reoujred Insoections:
1 Low Voltage: Prior to cover.
By Signature, I state and agree, that I have earefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that any and all work performed shall he done in aecordance with
the Ordinances of the City of Springfiel~'and the laws of the State of Oregon pertaining to the work described herein. I further
certify that only contractors and employees\who are in compliance with ORS 701.055 will be used on this project. I further agree
to ensure that aU required inspsct16ri,s""r~ ~e(j'u.ested at the proper time, that each address is readable from the street, and that
the approved set of plans, if'applicable"will remain on the site at aU times during construction. (\0"
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~"\~,:()~-.:(oJ ,n'i>',;"( ,:<:\~ ,. '7\0."'- ~;;~1:\S ,
Owner or C~tractel;s,Slg~atu~t\}c' ",0\ . 'l:,o'V' 'l>~o t~te ~t>-\.\. V \\\'11 ?'t.'" ~ ~()'i\
".' ~C""~~\{\0\~~(,,~~p~'< ..'\\'.'?,~~.,o'i.{\'~ ~()"~ t.~~\\ ~~t;)t.'i\ \t>-~t;)()~~
r' ,I< ,oJ '0"v fClv\J c:'~ ~o\.f?\\",~. r;,~r>,'\ ,\\\'2> '? ~\tt.t;) I:)'i\ \'11 t>i
"o~~"")\,,,:;J:~ ,'?-'\ 0~\.0('\0~' nn.,?;?;. t>-~\\\~'t.~C't.~'{ ?'t.'i\\()'\)'
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Page 1 of I
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
ELE2003-00 155
ELE2003-00 155
ELE2003-00 155
Payments:
Type of Payment
Check
WiUi~~., I
C'''. I
'._._~~' .~__.c.. .-;"
Receipt #: 1200200000000001596
Description
+ 10% Administrative Fee
+ 7% State Surcharge
Low Voltage - Commercial Indus
Paid By Received By
CACHE V ALLEY ELECTRIC CO djb
Check Number
Batch Number Authorization Number
City of Springfield Official Receipt
Development Services Department \
Public Works Department.
Date: 06/20/2003
8:39:29AM
Amount Paid
Item Total:
4.50
3.15
45.00
$52.65
How Received
In Person
Payment Total:
Amount Paid
$52.65
$52.65
.
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